Albert and Gustav Döderlein -- a critical view to the biographies of two German professors

Albert D?derlein and his son Gustav had as professors in Munich and Jena a formative influence on the German gynecology in the first half of the 20(th) century. Albert D?derlein discovered the lactobacillus named after him and its function, he was one of the first who employed radiotherapeutics in cancer therapy and introduced the rubber glove in obstetrics and gynecology. But he also wrote the gynecologic text to the "Bill for prevention of progeny suffering from an inherited disease dated 14(th) June 1933". After his time at the university hospital Charité, between 1936 and 1945 he was medical superintendent of the department of gynecology and obstetrics at the Police Hospital in Berlin. He can be regarded as the founder of antenatal care in Germany. Both scientific and historic aspects of the biographies of these two professors are critically looked right past.     

Creation of a neovagina according to Wharton-Sheares-George in patients with Mayer-Rokitansky-Küster-Hauser syndrome

OBJECTIVE: To introduce a simple and quick surgical alternative for creating a neovagina in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome that offers good anatomic and functional results. DESIGN: Historical report. SETTING: Tertiary center for gynecologic endocrinology. PATIENT(S): Three patients with MRKH syndrome. INTERVENTION(S): The creation of a neovagina according to Wharton-Sheares-George in patients with MRKH syndrome. MAIN OUTCOME MEASURE(S): Axis, length, and width of neovagina. RESULT(S): The George modification of the Wharton-Sheares neovaginoplasty was successfully performed in three patients. The results were excellent (normal axis and adequate length and width of neovagina), and there were no major complications. CONCLUSION(S): The George modification of the Sheares technique represents a simple, safe, and effective surgical option for creating a neovagina. The procedure is not highly complex and is therefore easy to learn and perform; no special surgical equipment is needed. Anatomic and functional results are very satisfying. Short-term hospitalization, accelerated recovery, and a rapid return to everyday life are important benefits for these young patients. These benefits also result in lower surgery-related expenses and therefore reduce the strain on the hospital's budget compared with other therapeutic options. The creation of a neovagina according to Wharton-Sheares-George might provide a satisfactory alternative for the surgical management of vaginal aplasia in patients with MRKH syndrome.     

Are the immediate complications of conisation with the large loop similar to those with the knife?

One hundred patients underwent conisation with large loop excision of the transformation zone. The overall immediate complication rate was 6%. There were no preoperative complications. Three patients were treated with antibiotics for infection and three patients had a secondary haemorrhage. No patient required a blood transfusion or cervical suturing and no patient returned to the operating theatre.     

Results of in vitro fertilization in patients with endometriomas: is surgical removal beneficial?

OBJECTIVE: The purpose of this study was to investigate the effect of endometriomas on clinical pregnancy rates of in vitro fertilization-embryo transfer. STUDY DESIGN: Infertile patients with endometriosis who underwent in vitro fertilization-embryo transfer were divided into group 1 patients who had a history of ovarian endometriomas and group 2 patients who did not. The patients in group 1 were further divided into group 1A who had their endometriomas removed by laparoscopic ovarian cystectomy before the start of in vitro fertilization-embryo transfer and group 1B who underwent in vitro fertilization-embryo transfer with the presence of endometriomas. The clinical pregnancy rates of these groups were compared. RESULTS: Clinical pregnancy rates per transfer were similar in group 1 and group 2 (40% vs 47%; P =.38) and similar in patients in group 1A and group 1B (47% vs 34%; P =.28), although the direction was toward improved pregnancy rates in the groups of patients without endometriomas present at the time of in vitro fertilization stimulation. When patients >39 years of age were excluded, the overall pregnancy rate was higher in those patients who had no current endometriomas than in those patients who had endometriomas present at the time of stimulation (65% vs 39%; P =.05). For patients with unilateral endometriomas, similar numbers of mature oocytes were aspirated between the affected and unaffected ovaries. CONCLUSION: Although the history of endometriomas does not appear to affect in vitro fertilization-embryo transfer outcomes adversely, there may be a benefit in the removal of endometriomas before in vitro fertilization.     

Screening history of women in Malmö with invasive cervical cancer

Objectives

Cervical cancer is one of the most common forms of cancer among women. Cytological screening and follow-up are potentially effective procedures for preventing the development of – and mortality from – cervical cancer. The purpose of this study was to investigate the screening history of women diagnosed with cervical cancer with the aim of improving the screening programme.

Study design

All of the 187 women diagnosed with invasive cervical cancer in Malmö between 1991 and 2000 were identified, and those below 61 years of age (n = 130) were included in the analysis. The cytological and histological screening history of these women prior to their diagnosis was scrutinized. We analyzed shortcomings related to the cervical screening with special attention to participation defined as having had a cervical smear within 1 year of the scheduled time.

Results

Of the non-participants who developed cervical cancer (n = 70), roughly one-third “never participated,” half were “sub-optimal participants,” and one-sixth were “decliners,” i.e., women who declined the recommended measures. Among participants (n = 60), 80% were either “unexplained” (n = 35) or “misread as normal” (n = 13). The 9.5% subgroup of non-participants was at an 11-fold increased risk of being diagnosed with invasive cervical cancer.

Conclusion

The greatest reduction in cervical cancer would be realized if non-participants could be brought into the screening program.     

Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility

Objectiveto implement use of Roberts’ Coping with Labor Algorithm^© (CWLA) with laboring women in a large tertiary care facility.Designthis was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation.Settingthe project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year.Participantsfull, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change.Findingsa majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice.Implications for practicethis work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.     

Adherence of Lactobacillus plantarum P 17630 in soft-gel capsule formulation versus Döderlein's bacillus in tablet formulation to vaginal epithelial cells

BACKGROUND: To evaluate in vitro the adherence capability of two bacteria to vaginal epithelial cells (VEC) by comparing product A containing L. plantarum P 17630, in soft-gel capsule formulation* and product B containing D?derlein's bacillus, now classified as L. gasseri, in vaginal tablet formulation, marketed for many years in Italy. METHODS: The comparative study of two commercially available preparations followed an open, controlled trial. Collection of VEC samples was done in an ambulatory setting; the adherence tests were carried out at the Institute of Microbiology of the Università Cattolica del Sacro Cuore, Piacenza. The study was made on intact VEC, washed and drawn from 20 patients affected by bacterial vaginitis and/or vaginosis. One capsule or tablet, suspended in physiological solution, was mixed with a suspension of VEC. Adherence of lactobacilli to the VEC was counted by light microscopy and by CFU cultured on the plates. The type of adhesion was evaluated as well. RESULTS: The mean number of lactobacilli adhering to individual VEC was higher for product A containing L. plantarum P 17630. On the plate cultures, 10(6)-10(8) CFU/sample were found for product A, compared with 10(2)-10(4) CFU/sample for product B. L. plantarum P-17630 adhere prevalently to single cells, whereas L. gasseri adhere by forming small chains. CONCLUSIONS: Product A has a better capability of adherence to VEC than does product B. Even the type of adhesion of L. plantarum P 17630 enabled it to remain better attached to the VEC. The results suggest that in vivo product A may be more likely to provide better colonization, thus affording better protection of the vaginal milieu.     

Effect of Penile‐Extender Device in Increasing Penile Size in Men with Shortened Penis: Preliminary Results

IntroductionIt has been suggested that the application of penile‐extender devices increases penile length and circumference. However, there are a few scientific studies in this field.AimsThe aim of this study was to assess the efficacy of a penile‐extender (Golden Erect®, Ronas Tajhiz Teb, Tehran, Iran) in increasing penile size.MethodsThis prospective study was performed on subjects complaining about “short penis” who were presented to our clinic between September 15, 2008 and December 15, 2008. After measuring the penile length in flaccid and stretched forms and penile circumference, patients were instructed to wear Golden Erect®, 4–6 hours per day during the first 2 weeks and then 9 hours per day until the end of the third month. The subjects were also trained how to increase the force of the device during determined intervals. The patients were visited at the end of the first and third months, and penile length and circumference were measured and compared with baseline.Main Outcome MeasuresThe primary end point of the study was changes in flaccid and stretched penile lengths compared with the baseline size during the 3 months follow‐up.ResultsTwenty‐three cases with a mean age of 26.5 ± 8.1 years entered the study. The mean flaccid penile length increased from 8.8 ± 1.2 cm to 10.1 ± 1.2 cm and 10.5 ± 1.2 cm, respectively, in the first and third months of follow‐up, which was statistically significant (P < 0.05). Mean stretched penile length also significantly increased from 11.5 ± 1.0 cm to, respectively, 12.4 ± 1.3 cm and 13.2 ± 1.4 cm during the first and second follow‐up (P < 0.05). No significant difference was found regarding proximal penile girth. However, it was not the same regarding the circumference of the glans penis (9.3 ± 0.86 cm vs. 8.8 ± 0.66 cm, P < 0.05).ConclusionOur findings supported the efficacy of the device in increasing penile length. Our result also suggested the possibility of glans penis girth enhancement using penile extender. Performing more studies is recommended. Nikoobakht M, Shahnazari A, Rezaeidanesh M, Mehrsai A, and Pourmand G. Effect of penile‐extender device in increasing penile size in men with shortened penis: Preliminary results. J Sex Med 2011;8:3188–3192.     

Leptin concentrations in the peritoneal fluid of women with ovarian endometriosis are different according to the presence of a ‘deep’ or ‘superficial’ ovarian disease

Some studies have suggested a possible role of leptin, an active cytokine produced by adipocytes, in the pathogenesis of pelvic endometriosis. The present study was designed to assess leptin levels in the peritoneal fluid (PF) of women with the ‘deep’ or ‘superficial’ types of ovarian endometriosis. Twenty-seven women with a single ovarian endometrioma having a mean diameter between 3 and 5 cm were included in the study. Patients were divided into two groups according to the type of ovarian endometriosis: Group A (n = 11) consisted of women with ‘superficial’ endometriomas located at the ovarian surface; Group B (n = 16) included patients with ‘deep’ intra-ovarian endometriomas. Women undergoing laparoscopy for unexplained infertility and not affected by pelvic and/or ovarian endometriosis were considered as controls (Group C, n = 10). Patients with an ovarian endometrioma had significantly increased PF leptin concentrations than endometriosis-free controls (Groups A and B vs. Group C, p < 0.01). Patients with ‘superficial’ endometriomas had significantly higher PF leptin levels compared with patients with ‘deep’ endometriomas (Group A vs. B, p < 0.01). This difference remained significant after correction for the BMI; moreover, a positive correlation between PF leptin and BMI was observed in Groups B and C, but not in women with ‘superficial’ endometrioma (Group A). Our observations suggest that: (a) leptin could play an active role in promoting the development of ‘superficial’ ovarian endometriomas and (b) ‘superficial’ and ‘deep’ ovarian endometriomas could have a different pathogenesis.